Yang Kuhyun, Ahn Jae Sung, Park Jung Cheol, Kwon Do Hoon, Kwun Byung Duk, Kim Chang Jin
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
World Neurosurg. 2015 Feb;83(2):197-202. doi: 10.1016/j.wneu.2014.06.008. Epub 2014 Jun 13.
To evaluate the efficacy of a short interposition graft using saphenous vein or radial artery to connect the proximal superficial temporal artery and the M2 segments of the middle cerebral artery for the treatment of complex intracranial aneurysm.
From March 2007 to February 2012, short interposition graft bypass operations were performed in 13 patients with complex intracranial aneurysms. There were 6 ruptured aneurysms, including blood blister-like aneurysms in 3 patients, giant aneurysms in 2 patients, and fusiform dissecting aneurysm in 1 patient. Among 7 patients with unruptured aneurysms, there were 5 giant aneurysms and 2 large fusiform aneurysms in the M2 segment.
Parent artery occlusion with endovascular coiling (3 patients) or trapping by direct clipping (10 patients) was used to treat complex cerebral aneurysms. Complete occlusion of the aneurysm was demonstrated in 11 patients (85%); the other 2 patients did not demonstrate occlusion immediately postoperatively. Except for 2 patients who presented with poor-grade subarachnoid hemorrhage, patients (n = 11; 85%) demonstrated good scores on the Glasgow Outcome Scale. No new neurologic deficits developed in relation to insufficient blood flow through the bypass graft. In all 13 patients, graft patency was good at long-term follow-up (overall mean follow-up, 28.2 months).
Superficial temporal artery-middle cerebral artery bypass surgery using a short interposition graft for intracranial complex aneurysms seems to be safe and efficient hemodynamically after occlusion of the parent artery. It could be regarded as a good alternative to high-flow bypass surgery.
评估使用大隐静脉或桡动脉进行短段移植搭桥，连接颞浅动脉近端与大脑中动脉M2段，以治疗复杂颅内动脉瘤的疗效。
2007年3月至2012年2月，对13例复杂颅内动脉瘤患者进行了短段移植搭桥手术。其中6例为破裂动脉瘤，包括3例血泡样动脉瘤、2例巨大动脉瘤和1例梭形夹层动脉瘤。7例未破裂动脉瘤患者中，5例为M2段巨大动脉瘤，2例为大型梭形动脉瘤。
采用血管内栓塞（3例）或直接夹闭（10例）闭塞载瘤动脉来治疗复杂脑动脉瘤。11例患者（85%）动脉瘤完全闭塞；另外2例患者术后即刻未显示闭塞。除2例蛛网膜下腔出血分级差的患者外，患者（n = 11；85%）格拉斯哥预后评分良好。未因搭桥血管血流不足出现新的神经功能缺损。13例患者长期随访时移植血管通畅良好（总体平均随访28.2个月）。
对于颅内复杂动脉瘤，采用短段移植搭桥的颞浅动脉-大脑中动脉搭桥手术在载瘤动脉闭塞后血流动力学方面似乎安全有效。可被视为高流量搭桥手术的良好替代方案。
